Did Casey Cheat Death or The System?

Cosmas and Damian Transplant

Cosmas and Damian miraculously transplant the black leg of the Ethiopian onto the white body of the patient.

Most people don’t think much about organ transplantation¼ heart and liver transplants in particular. Yet, if you were Robert P. Casey, the 61 year old two-term governor of Pennsylvania, you would have had two years to think about it. In August 1991, doctors told Governor Casey he was suffering from hereditary amyloidosis, a rare disease that attacks and destroys the body’s vital organs. This would have been a death sentence for the average American.

Not so for Governor Casey. On June 13, 1993, he received both a new heart and liver within a few hours after reporting to the University of Pittsburgh’s Transplantation Institute for tests. The next day, the Governor was awake and doctors were giving him a 90% chance of survival. In fact, he was released from the hospital six weeks later on July 26. Most of us wished Governor Casey a speedy recovery and went about our business.

However, Governor Casey’s heart-liver transplant feeds the belief that the rich and powerful get organs while others die waiting. In the United States, an average of six patients die each day while waiting for a new heart or liver. At the same time, 100 possible donors die without volunteering to make their organs available for transplant. At any given time, there are about 6,000 patients on waiting lists, one fifth to one third of whom die each year. We simply must find an effective way of marrying potential donors with transplant candidates. The good news is that about 50% of those on the waiting lists get transplants. The bad news is that 50% don’t.

The length of time a patient spends on a waiting list varies. One year is average. Many patients die waiting for organs. The United Network for Organ Sharing maintains the list of eligible transplant candidates. UNOS is made up of 65 regional organizations that control and jointly manage organ distribution throughout the country. When doctors determine that one of their patients is a candidate for organ transplant, they enter the patient’s name and other pertinent medical data in UNOS computers. Doctors prescreen most medical information because there is so little time once a donor’s organs become available for transplant. In the case of a liver for example, the doctor must remove and cool it within fifteen minutes of the death of the donor. Once removed, it can be kept safely for only four hours.

So how did Governor Casey get to the top of the list so fast? Well, it seems that UNOS maintains a separate list for heart candidates and another list for patients needing a liver. They listed Governor Casey on still another list for patients needing both a heart and a liver… this is a very short list. Combined heart/liver transplants are rare. Doctors in the United States have done only six.

No one will ever know exactly how the beating heart of 34 year old, William Michael Lucas, ended up beating in the chest cavity of the most powerful man in Lucas’ home state. The New York Times reports that Lucas was brain dead as the result of injuries sustained in a beating a week earlier. The body of this unemployed man remained hooked up to a respirator keeping the organs vital until transplanted.

The questions that give those of us pondering the Casey Heart/Liver Transplant the most problems are these. First, when did the doctors and Mr. Lucas’ family decide to cease life support? If they made this decision prior to Governor Casey entering the University of Pittsburgh Transplantation Institute on 13 June, it raises a second question: why did they wait rather than give the organs to one or more of the 6,000 transplant candidates already on one of the lists? If they made the decision to terminate Mr. Lucas’ life support after Governor Casey entered the Transplantation Institute, it raises a different question: did Governor Casey’s need of a new heart and liver influence those making the decision to terminate life support for Mr. Lucas, given the remarkable timing of the two events.

I don’t see any way our society can avoid asking these questions. We are not the first ones to ponder this issue. Girolamo da Cremona a fifteenth century artist addressed society’s transplantation dilemma with his painting, “Saints Comas and Damian Transplanting a Leg,” which hangs in the museum of the Church of San Marco, in Florence, Italy. The painting depicts a white patient lying in bed with a black leg grafted to his body in the place of an infected white leg that is cut off and laying on the floor. Off in the background, the artist draws a black man in a casket with one leg.

I can only speculate how 25th century history will depict the Casey-Lucas transplant 450 years from now. I can only hope that by then it won’t matter that one was white and powerful, while the other was black and poor; just as is depicted by Girolamo da Cremona’s painting “Saints Cosmas and Damian Transplanting a Leg.”

Originally Published: 4 August 1993, Montgomery Advertiser
© Copyright – 1993 – Major W. Cox and Montgomery Advertiser.

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